{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T21:21:03Z","timestamp":1790371263374,"version":"4.1.0"},"reference-count":48,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2021,1,25]],"date-time":"2021-01-25T00:00:00Z","timestamp":1611532800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100001511","name":"Auckland Medical Research Foundation","doi-asserted-by":"publisher","award":["1108004"],"award-info":[{"award-number":["1108004"]}],"id":[{"id":"10.13039\/501100001511","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2021,8]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Cardiotocography is widely used to assess fetal well\u2010being during labour. The positive predictive value of current clinical algorithms to identify hypoxia\u2010ischaemia is poor. In experimental studies, fetal hypotension is the strongest predictor of hypoxic\u2010ischaemic injury. Cohort studies suggest that deceleration area and deceleration capacity of the fetal heart rate trace correlate with fetal acidaemia, but it is not known whether they are indices of fetal arterial hypotension.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Prospective, controlled study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Laboratory.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Sample<\/jats:title>\n                    <jats:p>Near\u2010term fetal sheep.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      One minute of complete umbilical cord occlusions (UCOs) every 5\u00a0minutes (1:5\u00a0min,\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a06) or every 2.5\u00a0minutes (1:2.5\u00a0min,\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a012) for 4\u00a0hours or until fetal mean arterial blood pressure fell &lt;20\u00a0mmHg.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcome measures<\/jats:title>\n                    <jats:p>Deceleration area and capacity during the UCO series were related to evolving hypotension.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The 1:5\u00a0min group developed only mild metabolic acidaemia, without hypotension. By contrast, 10\/12 fetuses in the 1:2.5\u2010min group progressively developed severe metabolic acidaemia and hypotension, reaching 16.8\u00a0\u00b1\u00a00.9\u00a0mmHg after 71.2\u00a0\u00b1\u00a06.7 UCOs. Deceleration area and capacity remained unchanged throughout the UCO series in the 1:5\u2010min group, but progressively increased in the 1:2.5\u2010min group. The severity of hypotension was closely correlated with both deceleration area (\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0&lt;\u00a00.001,\n                      <jats:italic>R<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u00a0=\u00a00.66,\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a018) and capacity (\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0&lt;\u00a00.001,\n                      <jats:italic>R<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u00a0=\u00a00.67,\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a018). Deceleration area and capacity predicted development of hypotension at a median of 103 and 123\u00a0minutes before the final occlusion, respectively.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Both deceleration area and capacity were strongly associated with developing fetal hypotension, supporting their potential to improve identification of fetuses at risk of hypotension leading to hypoxic\u2010ischaemic injury during labour.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Tweetable abstract<\/jats:title>\n                    <jats:p>Deceleration area and capacity of fetal heart rate identify developing hypotension during labour\u2010like hypoxia.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/1471-0528.16638","type":"journal-article","created":{"date-parts":[[2020,12,28]],"date-time":"2020-12-28T16:38:09Z","timestamp":1609173489000},"page":"1433-1442","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":28,"title":["Deceleration area and capacity during labour\u2010like umbilical cord occlusions identify evolving hypotension: a controlled study in fetal sheep"],"prefix":"10.1111","volume":"128","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5543-6683","authenticated-orcid":false,"given":"A","family":"Georgieva","sequence":"first","affiliation":[{"name":"Nuffield Department of Women\u2019s and Reproductive Health The John Radcliffe Hospital University of Oxford Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8937-0846","authenticated-orcid":false,"given":"CA","family":"Lear","sequence":"additional","affiliation":[{"name":"Fetal Physiology and Neuroscience Group Department of Physiology The University of Auckland Auckland New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"JA","family":"Westgate","sequence":"additional","affiliation":[{"name":"Fetal Physiology and Neuroscience Group Department of Physiology The University of Auckland Auckland New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4400-8288","authenticated-orcid":false,"given":"M","family":"Kasai","sequence":"additional","affiliation":[{"name":"Fetal Physiology and Neuroscience Group Department of Physiology The University of Auckland Auckland New Zealand"},{"name":"The Department of Obstetrics and Gynecology Yokohama City University Yokohama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5492-0844","authenticated-orcid":false,"given":"E","family":"Miyagi","sequence":"additional","affiliation":[{"name":"The Department of Obstetrics and Gynecology Yokohama City University Yokohama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1489-4810","authenticated-orcid":false,"given":"T","family":"Ikeda","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Mie University Mie Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0656-7035","authenticated-orcid":false,"given":"AJ","family":"Gunn","sequence":"additional","affiliation":[{"name":"Fetal Physiology and Neuroscience Group Department of Physiology The University of Auckland Auckland New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4336-7596","authenticated-orcid":false,"given":"L","family":"Bennet","sequence":"additional","affiliation":[{"name":"Fetal Physiology and Neuroscience Group Department of Physiology The University of Auckland Auckland New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,1,25]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.3109\/14767058.2016.1174207"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2016.05.046"},{"key":"e_1_2_6_4_1","first-page":"CD006066","article-title":"Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour","volume":"2","author":"Alfirevic Z","year":"2017","journal-title":"Cochrane Database Syst Rev."},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199603073341001"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.1975.tb00699.x"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1515\/jpme.1976.4.2.118"},{"key":"e_1_2_6_8_1","first-page":"292","article-title":"A study of fetal heart rate deceleration areas. 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